IMAGING GROUP
Body and Orthopedic Imaging
A Guide to Ordering MRI and CT Imaging Studies
.
HOW and WHEN do I order CONTRAST for CT?
• General Principle: Almost always, CTs should be ordered “with” OR “without” only - NOT BOTH.
• General principle: Survey exams for pain or other non-specific symptoms can be
performed “without IV contrast only”
HOW and WHEN do I order CONTRAST for MRI?
• General Principle: All MRIS ordered with contrast should be ordered “without and with.”
• General Principle: If the patient’s GFR is below 30, contrast should not be given
If you have any questions on a particular case scenario, please do not hesitate to call one of our radiologists.
Body and Orthopedic: CT Studies
Diverticulitis, Hernia
Appendicitis
CT Chest for possible or
follow up nodules
CT possible vascular pathology,
abscess, mass
CT known visceral mass
WITHOUT
Best WITH, but can be done WITHOUT
WITHOUT
WITH
WITHOUT AND WITH(usually multiphase)
Body and Orthopedic: MRI Studies
Abdominal MRI
WITHOUT AND WITH
Pelvic MRI (including prostate)
Thoracic MRI
WITHOUT AND WITH
WITHOUT AND WITH
ANY Orthopedic/Musculoskeletal examinations in
the absence of a known or palpable mass.
WITHOUT
ANY Orthopedic/Musculoskeletal examinations to
asses a known or palpable mass.
WITHOUT AND WITH
www.tristateimaging.com
IMAGING GROUP
Neuroradiology
A Guide to Ordering MRI and CT Imaging Studies
HOW and WHEN do I order CONTRAST for CT?
• General Principle: Almost always, all CT heads only done WITHOUT contrast
HOW and WHEN do I order CONTRAST for MRI?
• General Principle: All MRIS ordered with contrast should be ordered “without and with.”
• General Principle: If the patient’s GFR is below 30, contrast should not be given
If you have any questions on a particular case scenario, please do not hesitate to call one of our radiologists.
Neuroradiology: CT Studies
CT Brain
Order “WITHOUT AND WITH” only if-------->
CT Cervical/Thoracic/Lumbar Spine
- Specifically assessing for metastatic
disease in a patient contraindicated for MRI
WITHOUT except possible abcess or neoplasm
CT Orbit and/or CT Sinus
Order “WITH ONLY” if the following apply------->
Otherwise, order “WITHOUT”
CT Neck
- Clinical Suspicion for infection
- Known history of orbital tumor
(if MRI contraindicated)
- WITH ONLY, unless specifically looking for salivar
gland stone(WITHOUT ONLY)
CTA Head
ALWAYS WITH ONLY
CTA Neck
ALWAYS WITH ONLY
Neuroradiology: MRI Studies
MRI Brain
Order “WITHOUT AND WITH” only if-------->
Otherwise, order “WITHOUT ONLY”
MRA Brain
Order “WITH” only if-------->
Otherwise, order “WITHOUT”
- Known hx of cancer, metastatic disease, or any
brain mass.
- Vertigo/tinnitus (MRI IACs)
- Known MS, cranial neuropathy
- Pituitary or hormonal imbalance (MRI pit)
- Known hx of aneurysm clipping/coiling
- Known AVM
MRI Neck
Always WITHOUT and WITH
MRA Neck
Generally WITHOUT
MRI Brachial Plexus
Usually WITHOUT AND WITH
MRI Orbits
Always WITHOUT AND WITH
MRV Brain
Always WITHOUT
MRI Cervical Spine
Order “WITHOUT AND WITH” only if-------->
Otherwise, order “WITHOUT ONLY”
MRI Thoracic/Lumbar Spine
Order “Without and With” only if-------->
Otherwise, order “WITHOUT ONLY”
-
Known hx or cancer, metastatic disease
Known hx of spinal cord mass
Known MS
Suspected epidural abcess or discitus/osteomyelitis
Known hx or cancer, metastatic disease
Known hx of spinal cord mass
Known MS (MRI TSpine only)
Previous spinal injury (winin 5 years)
Suspected epidural abcess or discitus/osteomyelitis